We ask all new patients to our practice to complete a few forms that help us provide you the best of service and care.  To download these forms, just click below:

   Billing Information Form

   Initial Medical History Form

   Cosmetic Interest Questionnaire

Please bring the completed forms with you and return them to the receptionist upon your arrival.  You must bring in all of your insurance cards.  In addition, any co-pay or deductible required by your health plan must be paid at the time of your visit. 

We also suggest that you become familiar with our Financial Policy Statement.   This document explains about insurance and your responsibilities to ensure that we help you enjoy the full benefit of that insurance.

If we do not participate with your health plan or if you do not have health insurance, we do want to take care of you.  In today’s turbulent health care market, we do not participate with every health plan.  However, we do want to provide care and services to all.  

To accommodate those patients who have a plan with whom we do not participate, we will submit a bill to your insurance company for services rendered.  You should expect to receive a check from the plan payable to you which at least partly covers the amount you paid.

For those who have health insurance but with limited out-of-network coverage, or for those with no health insurance at all, you may elect to be charged for services on a time basis for diagnostic care including all testing performed in our office.  The tests include hearing tests, x-rays, allergy tests, and breathing tests.  These services would not be submitted for insurance coverage as plans do not recognize inclusive medical services billed on a time basis.

Payment for services is due at the time the services are rendered,

For those who have time constraints and prefer on-line booking, at this time we include on-line scheduling for cosmetic consultations with Dr. Levine or hearing tests with Ms. Schary.  Click the icon below to see this feature.

We use every effort to accommodate your needs in scheduling appointments. Please help us serve you better by keeping scheduled appointments. With the large volume of patients whom we serve, if you need to cancel your appointment, please do so no less than 24 hours before, barring any emergency, so we may make your appointment time available to others on our wait list. If you are unable to cancel your appointment without notifying us a missed appointment fee of one hundred dollars will be assessed.

HIPAA Notice of Privacy Practices

Drug Authorization Policy